Mental Health

Question 1

signs and symptoms of serotonin toxicity

Answer 1

mental: agitation, confusion, delirium
autonomic: diarrhea, sweating, increased temp
neuromuscular: tremor, clonus, hyperreflexia

Question 2

how do you know serotonin toxicity is severe

Answer 2

temp >38.5

muscle hypertonicity

Question 3

mild serotonin syndrome

Answer 3

tremor

diarrhea

Question 4

diagnosis of serotonin syndrome

Answer 4

complete history and clinical presentation

Question 5

how is NMS diff from ST

Answer 5

immobile
constipation
pallor
no seizures

Question 6

when does ST present

Answer 6

within 1-24hr of dose increase of drug added
2/3 in 6 hr
3/4 in 24hr

Question 7

MAOi + serotonin

Answer 7

immediately go to ICU life threatening

Question 8

SSRI only OD

Answer 8

go to hospital often not life threatening but will worsen

Question 9

moderate ST

Answer 9

mood elevation
confusion
sweating, mydriasis, increased HR

Question 10

what to do in mild ST

Answer 10

go see doctor

usually just stop the drug or decrease dose

Question 11

pathophysiology of ST

Answer 11

drugs that increase production, decrease reuptake, decrease metabolism, increase release
work at the 2A receptors

Question 12

triptan risk of ST

Answer 12

0.03%

very unlikely because works at different receptors

Question 13

use of antipyretic in ST?

Answer 13

no bc increased temp due to excessive muscarinic activity rather than the thermoregulatory centre

Question 14

loperamide in ST?

Answer 14

nope lol also dueto excessive muscarinic activity??

Question 15

treatment of mild ST

Answer 15

stop offending agent

benzo for agitation and hypertonicity

Question 16

treatment of moderate ST

Answer 16

benzo - to treat agitation and tremors, prevent rhabdo lactic acidosis, hyperthermia
maybe cyproheptadine

Question 17

treatment of severe ST

Answer 17

sedation, intubation
active cooling
neuromuscular paralysis
cyproheptadine

Question 18

what is cyproheptadine

Answer 18

binds to 5HT receptors - antagonist

Question 19

dosing of cyproheptadine

Answer 19

12mg stat then2mg every 2hr

Question 20

monitoring for effiacy

Answer 20

symptom resolution
should resolve in 24-72hr in mild-mod
GI and CNS in 3-5day
if not improving or worsening go to hospital

Question 21

monitoring safety

Answer 21

new med side effects

educate on ST and drugs to avoid

Question 22

how long for antidepressants to take effect

Answer 22

1-3 for physical symptoms

4-6 for mood

Question 23

why is suicide increased with antidepressant

Answer 23

increased physical activity but decreased mood
frustration due to delayed onset
antidepressant induced restlessness common in chilldren

Question 24

duration of antidepressant treatment

Answer 24

at least 6-12month has been shown to decrease relaspse rate

Question 25

when do you treat for more than 2 years

Answer 25

3rd episode old frequent episodes psychotic

Question 26

withdrawal symptoms

Answer 26

dizzy insomnia electric shock nausea vomiting

Question 27

duration of withdrawal

Answer 27

occurs in 1-3 days can last 2weeks

Question 28

drugs with sig withdrawal

Answer 28

venlafaxine | paroxetine

Question 29

5 SSRI side effects

Answer 29

``` sexual dysfunction GI upset activation/insomnia restlessness/tremor sweating ```

Question 30

which SSRI has QRS prolongation

Answer 30

citalopram | increased risk with previous arrythmia, or on QT prolonging meds or diuretics

Question 31

expected reponse from antidepressants

Answer 31

100% decrease in 6mon | sig improvement from baseline